Effect of decision aid intervention on fear of falling in elderly patients after total hip arthroplasty / 中国实用护理杂志

Objective:To investigate the intervention effect of decision aid on the fear of falling in elderly patients after total hip arthroplasty.Methods:This study was a quasi experimental research. From June 2021 to November 2021, 84 patients after total hip arthroplasty who were admitted to the Department of Orthopedics of Zhengzhou Central Hospital Affiliated to Zhengzhou University were selected as the research objects. According to the order of admission, they were divided into the control group (42 cases, 2 cases fell off ) and the observation group (42 cases). The control group was given routine nursing care and guidance for fear of falling, while the observation group was given a decision-making aid intervention program on the basis of the control group. The time to first getting out of bed, the scores of Modified Falls Efficacy Scale (MFES), Generalized Anxiety Disorder (GAD-7) and Harris Hip Score (HHS) were compared between two groups.Results:The time to get out of bed for the first time in the observation group was (42.71 ± 6.41) h, lower than that in the control group (49.95 ± 5.73) h, and the difference was statistically significant ( t=5.38, P<0.05). Twelve weeks after discharge, the GAD-7 score in the observation group was (4.64 ± 1.43), which was lower than that of the control group (6.85 ± 1.83), and the difference was statistically significant ( t=6.10, P<0.05). The score of the MFES in the observation group was [8.50(8.00,10.00)], which was higher than that in the control group [7.50(7.00,8.00)], and the difference was statistically significant ( Z=-6.26, P<0.05). The hip joint function score of the observation group was (81.74 ± 4.24), which was higher than that of the control group (74.30 ± 4.51), and the difference was statistically significant ( t=7.69, P<0.05). Conclusions:Decision support can advance the time of downward movement of elderly patients after total hip arthroplasty, reduce their anxiety and fear of falling, and improve hip function.

The epidemiological features and relational factors of accidental death among children under 5 years of age in rural Shaanxi Province / 西安交通大学学报(医学版)

【Objective】 To explore the epidemiological features and relational factors of accidental death among children under 5 years of age in rural area of Shaanxi Province. 【Methods】 A case-control study was conducted in the research, and children under 5 years old in nine National surveillance counties of Shaanxi were collected. The questionnaire of national survey of accidental injuries among children under 5 years of age was used to investigate the basic information of children, socio-demographic characteristics, child care status, injury occurrence condition. The mean, standard deviation and percentage were used to describe the basic situation and main characteristics of accidental death. The Chi-square test and Logistic regression methods were performed to explore the relational factors of accidental death of children. 【Results】 Of the 25 cases of accidental death of children under the age of five years old, 5 were traffic accidents (20.0%), 9 cases were falling (36.0%), and 11 were suffocation (44.0%). Age distribution showed that children of accidental suffocation were younger, with 90.9% (10 cases) of them under the age of 1 years old. Gender distribution showed that traffic accident deaths occurred to boys. Area distribution showed that falling and suffocation death mainly happened in Hanzhong, while traffic accidents death mainly in Weinan. When the accident happened, 8 caregivers were not on the scene. What was worse, among 17 caregivers who were on the scene of accident, only 4 kept an eye on children. Compared with 25 children in control group, 16 in case group had received health examination, and the difference showed statistical significance (χ2=8.672, P=0.003). Meanwhile, 9 main caregivers were mothers in the case group, compared with 14 in the control group. The Logistic regression analysis showed that compared with fathers, mothers as the children’ main caregivers could positively reduce accidental death of children (OR=0.016, 95% CI: 0.000 3-0.997, P=0.049). 【Conclusion】 To decrease the incidence rate and mortality of accidental death of children under the age of five years old, parenting behavior guidance, health examination, and targeted health education should be taken in Maternal and Child Health Care System as a routine work.

The sward height at the early stockpiling period modifies the structural characteristics of marandu palisadegrass under continuous stocking

The control of sward height at the early stockpiling period influences the structural characteristics of stockpiled sward in winter. So, we conducted this work on the Cerrado region of Brazil based on the hypothesis that the reduction of pasture height at the beginning of stockpiling period results in: (i) lower stock of forage mass; and (ii) higher live leaf mass, but lower stem mass in stockpiled pasture during the winter. The treatments were four sward heights (15, 25, 35, and 45 cm) at early stockpiling period of marandu palisadegrass (Brachiaria brizantha syn. Urochloa brizantha cv. Marandu). The experiment was conducted in a completely randomized design, with three replications (paddocks with 800 m²). The stockpiled swards were evaluated during the grazing period in winter on days 7 (beginning), 45 (middle) and 90 (end). The vegetative tiller number (VEGT), live leaf mass (LLM) and leaf area index (LAI) were greater in the 15 cm stockpiled pasture than the other treatments. Greater heights (35 and 45 cm) at stockpiling resulted in greater forage mass than lower heights (15 and 25 cm). The VEGT, LLM, number of reproductive tillers, live stem mass, forage mass and LAI values were higher at the beginning than at the end of the grazing period. Our hypothesis has been proven, so that the reduction of sward height of the marandu palisadegrass at the beginning of the stockpiling period results in lesser forage mass, but with better structural characteristics.

How does the initial sward height and the grazing period influence the spatial variability of vegetation in deferred signal grass pastures?

The objective of this study was to evaluate the spatial variability of structural characteristics of deferred pastures of Brachiaria decumbens cv. Basilisk (signal grass) subjected to associations of sward heights (10, 20, 30, and 40 cm) at the beginning of deferment and grazing periods (1, 28, 56, 85, and 113 days). The experiment was arranged in a split-plot and completely randomized-block design with two replicates. Pastures remained deferred from March to June 2010. From June to the beginning of October 2010, deferred pastures were utilized by steers under continuous grazing and at a fixed initial stocking rate of 3.5 AU ha-1. At the beginning of the deferment, the coefficient of variation (CV) for pasture height was reduced linearly with the pasture height. During the grazing period, in the winter, the CV for pasture height was not influenced by initial pasture height; however, it responded quadratically to the grazing period, with a maximum value of 36.4% at 71 days of the period of utilization. The CV for tiller height was reduced linearly with pasture height at the beginning of deferment but increased linearly along with the grazing period. The initial pasture height did not change the CV of the falling index. However, the latter was quadratically influenced by the grazing period, with a maximum value of 59.5% at 67 days of the utilization period. Signal grass pastures deferred at a lower height have a higher spatial variability of the vegetation. In the grazing period, there are changes in the spatial variability of the vegetation of the deferred signal grass.

Development and validation of caregivers′knowledge-attitude-practice scale on safety precautions of children′s falling from bed in hospital / 中国实用护理杂志

Objective:To develop a scale of caregivers′ knowledge, attitude and practice (KAP) on safety precautions of children′s falling from bed in hospital, and test its reliability and validity.Methods:Based on the theory of KAP, the item pool was constructed by literature review and expert consultation. A convenient sampling method was used to investigate 380 caregivers of children admitted to Shanghai Children′s Medical Center, School of Medicine, Shanghai Jiao Tong University in May 2021. The reliability and validity of the scale was tested. Critical ratio method and correlation analysis method were used for item analysis of the scale. Validity analysis was conducted by detecting content validity and construct validity; reliability analysis was conducted by detecting internal consistency reliability and split-half reliability.Results:The formal scale finally developed comprised 17 items in 3 dimensions on knowledge, attitude and practice. The Cronbach′s α coefficient and split-half reliability of the overall scale were 0.739 and 0.841. The content validity of the scale was 0.991, and the content validity of each item was 0.890-1.000. Exploratory factor analysis has extracted 3 common factors, and the cumulative variance contribution rate was 60.57%.Conclusion:The scale of caregivers′ KAP on safety precautions of children′s falling from bed in hospital has good reliability and validity, and can be used as a tool to evaluate the knowledge, willingness or behavior of caregivers' participation in preventing falls.

Psychological experience of falling in elderly patients with acute myocardial infarction after PCI: a qualitative study / 中国实用护理杂志

Objective:To investigate the fall-related psychological experience of elderly patients with acute myocardial infarction (AMI) after percutaneous coronary intervention (PCI).Methods:A descriptive research method was used. A total of 15 elderly patients with AMI who received PCI in Hefei Second People′s Hospital from April 2021 to July 2021 were selected by the maximum difference sampling method for semi-structured interview. Colaizzi seven-step analysis method was used to analyze the data.Results:The fall-related psychological experience of elderly AMI patients after PCI could be divided into three themes: abnormal perception of fall risk (insufficient perception of fall risk, enhanced perception of fall risk); negative emotional distress of falling (fear of falling, foreboding sadness of falling outcome); the need for a safe home environment and a supportive monitoring system (need a safe home environment, rely on family/health care staff for support and supervision, lack of self-management information on falling prevention at home).Conclusions:Elderly patients with AMI have abnormal perception of risk of fall after PCI, and have negative emotions such as fear and sadness for postoperative fall. There is a certain demand for environmental safety and fall prevention support and supervision system in home cardiac rehabilitation. Nursing staff should formulate personalized early warning and intervention measures for them, pay attention to the psychological needs of patients, promote the role adaptation of patients, and provide continuous health services to prevent falls at home.

Influencing Factors of Horizontal Movement Distance of Bodies in High Falling Deaths / 法医学杂志

OBJECTIVES@#To explore the influencing factors of the horizontal distance of bodies in the high falling scene and the feasibility of inferring the falling mode based on it.@*METHODS@#A total of 614 high falling deaths and 15 cases of corpse dumping from high altitudes were collected. The relationship between the horizontal distance and the falling height, as well as the sex, age and manner of death (suicide, accident and corpse dumping) were observed.@*RESULTS@#The horizontal distance increased with the increase of falling height, and the difference among the height groups was statistically significant. The horizontal distance decreased with the increase of the age of the deceased, in each height group, the difference between the group over 60 years old and other age groups was statistically significant (P<0.05). The horizontal distance of male deceased was (1.99±0.27) m, which was greater than that of female deceased (1.88±0.19) m, and the difference was statistically significant in partial height groups (P<0.05). Roof falls had a greater horizontal movement distance than window falls. Except for the >20-30 m group, there was no significant difference in horizontal distance between suicide high falls and accidental high falls in other height groups.@*CONCLUSIONS@#The horizontal distance is affected by the falling height, the sex and age of the victim, and the spatial characteristics of the falling starting point.

Correlation between concern about falling and functional muscle fitness in community-dwelling elderly / Correlação entre preocupação em cair e aptidão muscular funcional em idosos comunitários

Abstract Introduction: To establish a correlation between concern about falling and a more comprehensive functional parameter, functional muscle fitness, a variable that encompasses functional components such as balance, muscle strength, power, flexibility and motor coordination in an integrated way. Functional muscle fitness is measured using the sitting-rising (from the floor) test (SRT), a simple, safe, fast and ecological test. Objective: The aim of our study was to determine the correlation between concern about falling and functional muscle fitness in the elderly. Methods: A cross-sectional observational study was conducted. The sample consisted of 53 elderly people of both sexes (86.8% women; 65.6 ± 4.7 years old; body mass index 28.5 ± 3.8 kg/m2), who were assessed for concern about falling (through Falls Efficacy Scale International, FES-I-Brazil) and functional muscle fitness (through SRT). Correlation analysis was performed using the Spearman test. For all analyses, a significance level of 5% (p < 0.05) was established. Results: Concern about falling showed a negative correlation with functional muscle fitness (rho =-0.229; p = 0.015). Conclusion: Elderly people with lower levels of functional muscle fitness have a higher level of concern about falling.

Resumo Introdução: Com o intuito de estabelecer uma correlação entre a preocupação em cair e um parâmetro funcional mais abrangente, a aptidão muscular funcional, variável que engloba componentes funcionais como equilíbrio, força, potência muscular, flexibilidade e coordenação motora de forma integrada, surge como uma alternativa. A aptidão muscular funcional é mensurada por meio do teste de sentar e levantar do chão (TSL), um teste simples, seguro, rápido e ecológico. Objetivo: A pesquisa teve como objetivo verificar a correlação entre a preocupação em cair e a aptidão muscular funcional de idosos. Métodos: Trata-se de um estudo com delineamento observacional do tipo transversal correlacional. A amostra foi composta por 53 idosos de ambos os sexos (86,8% mulheres; 65,6 ± 4,7 anos; índice de massa corporal 28,5 ± 3,8 kg/m2), avaliados quanto à preocupação em cair (através da Escala Internacional de Eficácia de Quedas Brasil - FES-I-Brasil) e à aptidão muscular funcional (através do TSL). A análise de correlação foi realizada pelo teste de Spearman. Para todas as análises foi estabelecido um nível de significância de 5% (p < 0,05). Resultados: A preocupação em cair apresentou correlação negativa com aptidão muscular funcional (rho =-0,229; p = 0,015). Conclusão: Idosos com menores índices de aptidão muscular funcional apresentam maior nível de preocupação em cair.

Concordancia entre pruebas de estabilidad unipodal estática para riesgo de caída en adultos mayores chilenos / Concordance between Static Unipodal Stability Tests concerning Risk of Falling in Chilean Aged Adults

Introducción: El equilibrio postural conforma parte de la evaluación funcional para riesgo de caída en adultos mayores. El Ministerio de Salud Chileno aplica el Test Estación Unipodal para valora la estabilidad unipodal estática como herramienta de prevención en salud. Objetivo: Determinar la concordancia o equivalencia diagnóstica entre el Test Estación Unipodal y el Test unipodal para estabilidad corporal estática, en modalidad ojos abiertos. Métodos: Estudio de concordancia diagnóstica, de tipo transversal; aplicado en 60 adultos mayores autovalentes pertenecientes a talleres deportivos del Gimnasio Olímpico de San Miguel, Región Metropolitana, Chile, quienes voluntariamente ejecutaron dos pruebas de estabilidad unipodal estática y respondieron un instrumento de consulta al final de la evaluación referida al Test unipodal para estabilidad corporal estática. Resultados: Entre las dos pruebas de estabilidad unipodal, en modalidad ojos abiertos, se presentó una concordancia significativa al evaluar buena o deficiente estabilidad (p = 0,0005). Los adultos mayores evaluados percibieron el Test unipodal para estabilidad corporal estática como prueba de fácil aplicación, bajo nivel de riesgo físico y cansancio, declarando intención de volver a realizarla si se requiere valorar nuevamente su estabilidad. Conclusión: Ambos métodos, Test Estación Unipodal y Test unipodal para estabilidad corporal estática, en modalidad ojos abiertos, fueron capaces de clasificar correctamente buena estabilidad o estabilidad deficiente en los adultos mayores evaluados. Por lo tanto, resultan equivalentes y concordantes para el diagnóstico de la estabilidad estática con apoyo unipodal(AU)

Introduction: Postural balance is part of the functional assessment for risk of falling in aged adults. The Chilean Ministry of Health applies the Unipodal Station Test to assess static unipodal stability as a health prevention tool. Objective: To determine concordance or diagnostic equivalence between the Unipodal Station Test and the Unipodal Test for static body stability, in the open eyes modality. Methods: Cross-sectional study of diagnostic concordance applied in sixty self-supporting aged adults belonging to sports workshops of the Olympic Gymnasium of San Miguel, in the Metropolitan Region of Chile, who voluntarily completed two static unipodal stability tests and answered a consultation instrument at the end of the assessment concerning the Unipodal Test for static body stability. Results: Between the two unipodal stability tests, in the open eyes modality, a significant concordance was present upon assessing good or poor stability (p = 0.0005). The aged adults who underwent assessment perceived the Unipodal Test for static body stability as a test of easy application and low level of physical risk and fatigue, as well as declared their intention to complete it again if their stability needed to be reassessed. Conclusion: Both the Unipodal Station Test and the Unipodal Test for static body stability, in the open eyes modality, were effective methods to classify good stability or poor stability correctly in the aged adults who underwent assessment. Therefore, they are equivalent and concordant for the diagnosis of static stability with unipodal support(AU)

Effect of early ambulation time in lower limbs muscle strength in patients with total knee arthroplasty / 中国实用护理杂志

Objective:To investigate the effect of early ambulation time on lower limbs muscle strength and fear of falling in patients with total knee arthroplasty, so as to provide basis for promoting the postoperative rehabilitation of patients undergoing total knee arthroplasty.Methods:A total of 210 patients after unilateral total knee replacement from July 2018 to December 2019 in the Second Affiliated Hospital of Soochow University were included and assigned to experimental group 1, experimental group 2 and experimental group 3 by random digits table method, each group contained 70 cases, and the patients began ambulation at 16, 20, 24 hours after knee replacement, respectively. The peak torque (PT) of knee joints flexors and extensor as well as hamstrings quadriceps ratio (H/Q) were compared among three groups at 1 week, 1 month and 3 months after knee replacement. The fall efficiency was evaluted by Modified Fall Efficacy Scale (MFES), the fear of falling rate was conducted by single item method.Results:After 1 month of knee replacement, the PT of knee joints flexor and extensor and H/Q were (18.73±5.49) N·m, (37.56±7.76) N·m, (48.08±9.19)% and (18.44±5.27) N·m, (37.04±7.07) N·m, (47.49±9.30)% in the experimental group 1 and experimental group 2, which were higher than those in the experimental group 3(16.38±2.85) N·m, (33.75±6.75) N·m, (43.48±7.17)%, the differences were statically significant ( t values were 2.316-3.057, P<0.05). After 1 week of knee replacement, the fear of falling rate were 72.3%(47/65) and MFES scores were (3.14±0.58) points in the experimental group 1, 53.7%(36/67), (3.81±0.65) points and 50.8%(32/63), (3.87±0.74) points in the experimental group 2 and experimental group 3, the fear of falling rate significantly increased and MFES scores significantly decreased in the experimental group 1 compared to the experimental group 2 and experimental group 3, the differences were statistically significant ( χ2 values were 5.780, 4.878, t values were 6.221, 6.129, P<0.05). Conclusions:Twenty hours after knee replacement is the best time for ambulation, which can shortern the time for lower limbs muscle strength recovery and reduce the risk of fear of falling.

Association between a hilly neighborhood environment and falls among rural older adults: a cross-sectional study / Journal of Rural Medicine

Objective: Falls in older adults are a major public health issue, and it is unclear whether the neighborhood environment is associated with falls among this group. This cross-sectional study investigated whether hilly neighborhood environmental factors were associated with fall status (falls or fear of falling) in rural Japanese older adults.Materials and Methods: Data obtained from 965 participants aged 65 years and older living in Unnan City, Shimane Prefecture, Japan, in 2017 were analyzed. Fall status was assessed based on the 1-year fall incidence (yes/no) for the past year and fear of falling (yes/no) using a self-report questionnaire. For hilly neighborhood environmental factors, the mean elevation and land slope were assessed using a geographic information system. The logistic regression model examined the odds ratios (OR) and 95% confidence intervals (CIs) of fall status in quartiles for elevation and land slope, respectively, and was adjusted for confounders.Results: Falls and fear of falling were observed in 16.8% and 43.2% of participants, respectively. Falls were associated with elevation (OR 1.99, 95% CI 1.17–3.37 for Q2 vs. Q1; OR 2.02, 95% CI 1.19–3.44 for Q3 vs. Q1) and land slope (OR 1.74, 95% CI 1.04–2.93 for Q3 vs. Q1; OR 1.74, 95% CI 1.04–2.93 for Q4 vs. Q1). Fear of falling was associated with elevation (OR 1.78, 95% CI 1.19–2.65 for Q3 vs. Q1) and land slope (OR 1.51, 95% CI 1.01–2.25 for Q4 vs. Q1).Conclusion: Our study found that elevation and land slope as hilly neighborhood environment factors were positively associated with falls or fear of falling among older adults living in rural Japan. Prospective observational studies that investigate the effects of region-specific environmental factors on falls among older adults should be conducted.

Análise da ocorrências de quedas em pacientes admitidos em unidades de cuidados críticos / Analysis of the occurrence of falls in patients admitted to critical care units

A queda é um dos eventos adversos mais frequentes na atenção terciária e sua ocorrência ocasiona danos às vezes irreversíveis ao paciente e ônus para seus familiares, instituições e profissionais de saúde. Para pacientes inseridos em unidades de cuidados críticos como centro cirúrgico, pronto socorro e unidade de terapia intensiva, dados sobre o evento queda, condutas após a mesma, complicações e desfechos intra-hospitalares ainda não estão consolidados para uma prática clínica diretiva e segura. Este estudo teve por objetivo analisar as ocorrências de quedas em pacientes adultos admitidos em unidades de cuidados críticos. Trata-se de estudo quantitativo, descritivo realizado em cinco hospitais gerais e de grande porte do município de Belo Horizonte. A coleta ocorreu por meio de consulta a 117 prontuários de pacientes adultos que sofreram quedas em unidades de cuidados críticos e cujo evento foi notificado ao Núcleo de Segurança do Paciente das instituições de abril de 2013 a dezembro de 2019. Foram investigados os dados sociodemográficos e clínicos, os relacionados ao evento queda, as complicações e os desfechos intra-hospitalares. As variáveis foram descritas por meio de frequência, porcentagens e medidas de tendência central. Predominou o sexo masculino (59,83%), que vive sem companheiro (35,04%) e na faixa etária de 60 anos ou mais (54,70%). As causas externas (25,64%), a hipertensão arterial sistêmica (47,00%) e o etilismo (23,08%) foram as características clínicas mais frequentes. As quedas foram mais frequentes no período da madrugada (27,35%), no Pronto Socorro (76,07%) e na maioria dos pacientes que estavam acomodados em maca (36,75%) ou na cama/leito (29,91%). Quanto ao grau de dano no momento da queda, predominou a categoria 'nenhum dano' (43,59%). Quase a metade dos pacientes (47,86%) não foi avaliada quanto a predição de quedas na admissão e 47,01% foi submetida à essa avaliação no dia do evento. A Morse Fall Scale foi aplicada em 26,50% destes pacientes. Quanto aos fatores de risco, 47,86% apresentavam agitação psicomotora/confusão mental e 16,24% alterações cognitivas, 18,80% estavam sob contenção química e 11,11% com contenção física dos membros superiores. Após a queda, o exame de imagem mais indicado foi a tomografia de crânio (19,06%). As complicações mais frequentes advindas da queda foram ferimentos corto-contusos (13,68%), escoriações (10,26%) e trauma cranioencefálico leve (9,40%). Mais da metade recebeu alta (52,14%) e 4,27% evoluíram a óbito por consequência da queda. Concluiu-se que as quedas ocorrem em pacientes admitidos em unidades de cuidados críticos e foram mais frequentes em pronto socorro e em pessoas idosas. O uso de escalas de predição é pouco frequente na admissão dos pacientes. Observou-se a necessidade de propedêutica adicional após a queda e o desfecho relacionado à queda é, por vezes, irreversível. É notória a necessidade de repensar a prática e buscar melhores estratégias quanto a prevenção de quedas visando uma assistência mais qualificada e segura para pacientes criticamente enfermos.

Falls are one of the most frequent adverse events in tertiary care and their occurrence causes sometimes irreversible damage to patients and burdens to their families, institutions and health professionals. For patients admitted to critical care units such as the operating room, emergency room and intensive care unit, data on falls, post-fall management, complications and in-hospital outcomes are not yet consolidated for a directive and safe clinical practice. This study aimed to analyze the occurrence of falls in adult patients admitted to critical care units. This is a quantitative and descriptive study carried out in five general and large hospitals in Belo Horizonte. The collection occurred through consultation of 117 medical records of adult patients who suffered falls in critical care units and whose event was reported to the Center for Patient Safety of the institutions from April 2013 to December 2019. Sociodemographic and clinical data, data related to the fall event, complications and in-hospital outcomes were investigated. The variables were described by means of frequency, percentages and measures of central tendency. There was a predominance of males (59.83%), living without a partner (35.04%) and in the age group of 60 years or older (54.70%). External causes (25.64%), hypertension (47.00%) and alcoholism (23.08%) were the most frequent clinical characteristics. Falls were more frequent in the early morning period (27.35%), in the Emergency Room (76.07%) and most patients were accommodated on a stretcher (36.75%) or in bed/bed (29.91%). As for the degree of injury at the time of the fall, the 'no injury' category predominated (43.59%). Almost half of the patients (47.86%) were not assessed for fall prediction on admission and 47.01% underwent assessment on the day of the event. The Morse Fall Scale was applied in 26.50% of these patients. As for risk factors, 47.86% had psychomotor agitation/acute confusions and 16.24% cognitive alterations, 18.80% were under chemical restraint and 11.11% with physical restraint of the upper limbs. After the fall, the most indicated imaging exam was the skull tomography (19.06%). The most frequent complications from a fall were blunt force injuries (13.68%), abrasions (10.26%), and mild traumatic brain injury (9.40%). More than half were discharged (52.14%) and 4.27% died as a result of the fall. Falls were more frequent in emergency rooms and in elderly people. The use of prediction scales is not frequent in the admission of patients. It was observed the need for additional propedeutics after a fall and the fall-related outcome is sometimes irreversible. It is notorious the need to rethink the practice and seek better strategies for fall prevention aiming at a more qualified and safer care for critically ill patients.

'A Queda do Céu': reflexões junguianas sobre o alerta xamânico de Davi Kopenawa / 'La caída del cielo': reflexiones junguianas sobre la alerta chamánica por Davi Kopenawa / 'The Falling Sky': Jungian reflections on the shamanic alert by Davi Kopenawa

Neste artigo serão apresentadas algumas considerações junguianas sobre a narrativa etnográfica intitulada "A Queda do Céu", buscando demonstrar, por meio de uma análise comparativo-reflexiva, perspectivas em comum entre a visão do xamã Yanomami, Davi Kopenawa e as ideias do Psiquiatra suíço, Carl Gustav Jung. Para tal, será necessário apresentar alguns princípios da crítica indígena sobre o modo de relação das sociedades tecnológicas com a natureza - marcada pela exploração dos recursos naturais e desrespeito à cultura indígena. Refletir sobre os pontos em comum entre esta visão nativa, descrita na obra em questão e a Psicologia Complexa, sobretudo pelo viés ao qual Jung denominou arquétipo psicóide, em que a relação corpo-mente-mundo encontra-se em ressonância e em íntima relação de interdependência. Sendo assim, o objetivo central deste trabalho é elaborar um diálogo entre o pensar mítico e a teoria junguiana, no sentido de observar de que modo ambas perspectivas apontam conexões intrínsecas entre natureza e cultura. ■

This study brings some Jungian considerations on the ethnographic narrative entitled "The Falling Sky" that will be presented seeking to demonstrate through a comparative-reflective analysis of similarities between the views of the Yanomami shaman, Davi Kopenawa and the ideas of the Swiss Psychiatrist, Carl Gustav Jung. To this end, it is necessary to present some points of indigenous criticism about the way in which technological societies relate to nature - marked by the exploitation of natural resources and disrespect for indigenous culture, reflecting on the similarities between this native view, described in this study and in Complex Psychology, mainly due to the bias Jung called the psychoid archetype, in which the body-mind-world relationship is in resonance and in an intimate interdependent relationship. Thus, the main objective of this study is to elaborate a dialogue between original thinking and Jungian thinking, in the sense of observing how both perspectives point to intrinsic connections between nature and culture. ■

En este artículo se presentarán algunas consideraciones junguianas sobre la narrativa etnográfica titulada "La caída del cielo", buscando demostrar a través de un análisis comparativo-reflexivo perspectivas en común entre la visión del chamán Yanomami, Davi Kopenawa y las ideas del psiquiatra suizo Carl Gustav Jung. Para ello, será necesario presentar algunos principios de la crítica indígena sobre la forma en que las sociedades tecnológicas se relacionan con la naturaleza, marcada por la explotación de los recursos naturales y la falta de respeto a la cultura indígena. Reflexionar sobre los puntos en común entre esta visión nativa, descrita en la obra en cuestión y la Psicología Compleja, especialmente debido al sesgo que Jung denominó arquetipo psicoide, en el que la relación cuerpo-mente-mundo está en resonancia y en una íntima relación de interdependencia. Por lo tanto, el principal objetivo de este trabajo es elaborar un diálogo entre el pensamiento mítico y la teoría junguiana, con el fin de observar cómo ambas perspectivas apuntan a conexiones intrínsecas entre naturaleza y cultura. ■

Effect of normal limbs active exercise rehabilitation training in fear of falling and motor function in patients with cerebral infarction after intervention / 中国实用护理杂志

Objective@#To investigate the effectiveness of normal limbs active exercise rehabilitation training in fear of falling and motor function in patients with cerebral infarction after intervention.@*Methods@#A total of 74 cerebral infarction after intervention patients were enrolled in Wanbei Coal-Electricity Group General hospital from May 2016 to April 2018. Patients were randomly divided into the observation group 37 patients and the control group 37 patients according to the random number table method. The control group received routine rehabilitation training, normal limbs active exercise rehabilitation was carried out in the observation group. After 3 months of intervention, the fear of falling, activities of daily living, limbs motor function was assessed by short Falls Efficacy Scale International (FES-I), Barthel index, Fugl-Meyer motor function scoring, respectively.@*Results@#Before intervention, the short FES-I score was (15.32±3.15) and (15.47±4.89) in the observation group and in the control group respectively, after intervention, the score was (10.21±2.67) and (12.28±4.05), respectively. There was no significant difference in short FES-I scores between the two groups pre-intervention (P> 0.05). However, the short FES-I scores were significantly decreased in the observation group compared to the control group at post-intervention (t value was 2.468, P<0.05). Before intervention, the scores of Barthel index, upper limb motor function, lower limb motor function were (33.15±7.08), (22.88±4.42), (15.31±3.38) in the observation group, and (33.40±3.78), (22.26±5.03), (16.04±3.30) in the control group, however, those index mentioned above were (47.96±8.45). There was no significant difference in Barthel index, motor function scores between two groups pre-intervention (P>0.05). However, those scores were significantly increased in the observation group compared to the control group at post-intervention (t value was 2.562, 2.878, 4.553, P<0.05).@*Conclusion@#Normal limbs active exercise rehabilitation training can alleviate the fear of falling and promote motor function and self-care ability of patients with cerebral infarction after intervention.

Factors affecting fall fear in the first movement of elderly patients after total knee or hip arthroplasty / 中国组织工程研究

BACKGROUND: Hip and knee arthroplasty is currently the fundamental measure to improve the severe joint dysfunction and pain caused by elderly hip and knee joint diseases. However, the fear of falling seriously affects the time for elderly patients to go to the ground, and it is clear that the elderly patients with hip and knee arthroplasty are afraid of falling. The occurrence factors have important guiding significance for the early clinical intervention of such patients. OBJECTIVE: To explore the factors influencing the fear of falling during the first ambulation after total knee arthroplasty and total hip arthroplasty in elderly patients. METHODS: 242 elderly patients who underwent hip and knee arthroplasty in Wuming Hospital, Guangxi Medical University from January 2015 to January 2019 were selected as the study subjects, and the incidence of fall fear was observed. The risk factors of fall fear were analyzed by single factor and multi-factor Logistic analysis. RESULTS AND CONCLUSION: (1) The incidence of fall fear was 65.6%. (2) The univariate analysis showed that there was no significant difference in gender and education level between patients with and without fear of falling (P > 0.05). There were significant differences in age, type of replacement, past fall history, pain score, anxiety, depression, types of chronic diseases and visual impairment between patients with and without fall fear (P < 0.05). (3) The multivariate Logistic analysis showed that age (≥70 years old), visual analogue scale pain score of 7-10, anxiety and past fall history were risk factors for falling fear (P < 0.05). (4) It is suggested that elderly patients have a higher incidence of fear of falling when going to the ground for the first time after hip and knee arthroplasties. Post-operative pain, anxiety, age and history of falling are risk factors affecting fear of falling. Clinical attention should be paid to these risk factors in order to alleviate fear of falling and promote early recovery.

Damage Analysis of Uncontrolled Falling of Micro-Miniature UAV on Human Head / 医用生物力学

Objective To evaluate the harmfulness of micro-miniature unmanned aerial vehicles (UAV) to human body, especially to head caused by accidental uncontrolled crash. Methods The dynamic numerical simulation analysis was carried out by using ABAQUS software. The free-falling UAV was simplified in different geometric shapes to impact human head and the damage degree of human head caused by the impact was analyzed. Based on the biological tissue performance parameters, human head and neck was simplified as a mass-spring system and the head was modeled with actual skin texture. Results When the UAV fell from 10 m with weight of 0.5 kg, the abbreviated injury scale (AIS) of the disc-shaped UAV was 1.04, and the AIS of the corn-shaped and sphere-shaped UVA were 1.95 and 2.48. For the UAV with the same geometric shape, as the mass and the falling height increased, both impact acceleration of the head and the AIS increased. When the UAV impacted human head at different angles, the disc-shaped UAV exhibited the smallest impact acceleration, AIS and damage degree. The corn-shaped and sphere-shaped UVAs had small differences in impact acceleration and AIS, but their damage degrees were large. Conclusions When the uncontrolled micro-miniature UAV impacts human head, the mass, height or contact shape of the UAV have a significant influence on the damage degree of human head.

Cross-cultural adaptation of the Iconographical falls efficacy scale / 中国实用护理杂志

Objective To translate the Iconographical Falls Efficacy Scale (Icon-FES)and verify its reliability and validity in community-dwelling older people. Methods After obtaining authorization, the Icon-FES was initially developed according to the guidelines for cross-cultural adaptation. Adopting a convenient sampling method, from December 2017 to March 2018, 450 older adults from 2 communities in Wuhan City were selected to fillgeneral information questionnaire, iconographical falls efficacy scale(Icon-FES)and falls efficacy scale-international(FES-I). Results The Cronbach α coefficient of Icon-FES was 0.972( the shorten Icon-FES was 0.902);split-half reliability was 0.947; retest reliability coefficient was 0.951. Based on the rotation factor component matrix and scree plot, 2 common factors were selected and the cumulative variance contribution rate was 67.33％.The Spearman rank correlation coefficient between Icon-FES and FES-I was 0.663. Conclusion Icon-FES has good reliability and validity in measuring the fear of falls in the community, especially for the elderly with low cultural level and strong activity in China. The shorten Icon-FES is also one of the quick and simple tools.

Backward Gait is Associated with Motor Symptoms and Fear of Falling in Patients with De Novo Parkinson's Disease

BACKGROUND AND PURPOSE: Many previous studies have investigated forward gait (FG), backward gait (BG), and dual-task gait (DG) in patients with Parkinson's disease (PD). However, it remains uncertain whether gait parameters are implicated in motor symptoms or the risk of falling, especially in patients with de novo PD. METHODS: Demographic and clinical characteristics including the Fear of Falling Measure (FFM) were assessed in patients with de novo PD and in healthy subjects. A computerized gait analysis using the GAITRite system was performed for FG, BG, and DG. The Unified Parkinson's Disease Rating Scale Part III was assessed in patients with PD. RESULTS: This prospective study included 24 patients with de novo PD and 27 controls. Compared with controls, patients with de novo PD showed a slower gait and shorter stride in all three gaits. Patients with de novo PD also exhibited increases in the stride-to-stride variability in the stride time and stride length of the gait for BG, increased length for DG, and no increase for FG. Moreover, the BG speed in de novo PD patients was significantly associated with their motor symptoms (bradykinesia, postural instability, gait difficulty, and total motor score) and negatively correlated with the FFM score. CONCLUSIONS: The BG dynamics were more impaired and more closely related to motor symptoms and fear of falling than were the FG or DG dynamics in patients with de novo PD, indicating that BG parameters are potential biomarkers for the progression of PD.

Thoracolumbar burst fracture: From injury causes to clinical symptoms / 第二军医大学学报

ObjectiveTo analyze the relationship between the factors causing thoracolumbar burst fracture and the corresponding clinical manifestations, so as to improve the early warning and diagnosis of thoracolumbar burst fracture, reduce the misdiagnosis and missed diagnosis, and improve the success rate of first aid. MethodsThe clinical data of thoracolumbar burst fractures treated in the Intensive Care Unit of Depretment of Emergency of our hospital from Jan. 2009 to Dec. 2018 were retrospectively analyzed. The clinical data, including age, sex, hospital duration, causes, complications, discharge, and prognosis, were analyzed retrospectively. Results A total of 83 patients with thoracolumbar burst fracture, including 69 males (83.13%) and 14 females (16.87%), were selected for this study. The average age was (44.64±15.26) years. The causes of the injury included: High falling injury (53 cases, 63.86%), traffic accident injury (17 cases, 20.48%), and heavy object injury (12 cases, 14.46%). There were 31 cases (37.35%) of craniocerebral injury, 53 cases (63.86%) of chest injury, 37 cases (44.58%) of abdominal injury, 44 cases (53.01%) of other fracture. Among the 53 cases of chest injury, there were 19 cases (35.85%) with hemopneumothorax, 13 cases (13.21%) with simple hemothorax, 7 cases (24.53%) with simple pneumothorax, 8 cases (15.09%) with mediastinal hemorrhage, 7 cases (13.21%) with mediastinal emphysema, 11 cases (20.75%) with flail chest, and 5 cases (9.43%) with diaphragmatic hernia. Among 37 cases of abdominal injuries, there were 8 cases (21.62%) with rupture of spleen, 3 cases (8.11%) with subcapsule hematomas, and 4 cases (10.81%) with simultaneous injury of liver and spleen. The missed diagnoses at the initial diagnosis included: 5 cases (100.00%) of diaphragmatic hernia, 5 cases (62.50%) of mediastinal hemorrhage, 4 cases (57.14%) of mediastinal emphysema, 2 cases (18.18%) of flail chest, and 2 cases (15.38%) of simple hemothorax. Missed diagnosis rate of the other complications were all under 10.00%. The main complications were bronchopneumonia (37 cases, 44.58%) and traumatic hemorrhagic shock (17 cases, 20.48%). There were 8 cases (9.64%) complicated with multiple organ dysfunction syndrome (MODS), with more than 3 systems involved. There were 39 patients (46.99%) had paraplegia and 3 cases (3.61%) died at discharge. ConclusionThoracolumbar burst fractures are more common in young and middle-aged men, with high falling being the primary cause and hemopneumothorax being the main clinical manifestation. Diaphragmatic hernia, mediastinal hemorrhage and mediastinal emphysema are easy to have missed diagnosis. Nearly 50% patients have traumatic paraplegia, which is worthy of attention and in-depth study.

Preditores do medo de cair em idosos portugueses na comunidade: um estudo exploratório / Predictors of the fear of falling among community-dwelling elderly Portuguese people: an exploratory study

Resumo O medo de cair é um fator de risco de queda. Também tem sido associado ao declínio funcional, diminuição da qualidade de vida e aumento do isolamento social na população idosa. Este estudo teve como objetivo analisar preditores do medo de cair em pessoas idosas portuguesas residentes na comunidade. Foi desenvolvido um estudo transversal com uma amostra de conveniência de 98 participantes (57,1% mulheres; média etária 74,07 ± 8,74 anos). O protocolo de coleta de dados incluiu um questionário sociodemográfico e de saúde, a Escala de Confiança no Equilíbrio específica para a Atividade, a Escala de Ansiedade e Depressão Hospitalar, a Escala Breve de Redes Sociais de Lubben, o Timed Up and Go, e o Teste de Sentar e Levantar Cinco Vezes. Os dados foram analisados com recurso à estatística descritiva e inferencial. Os resultados indicam que no gênero feminino (p = 0.01), a percepção de saúde física boa (p = 0.01) e moderada (p = 0.02) e os sintomas de depressão (p ≈ 0.00) são preditores do medo de cair. Controlar estes preditores é um aspecto fundamental para a promoção da independência das pessoas idosas, minimizando as consequências associadas ao medo de cair.

Abstract The fear of falling constitutes a real risk factor for falls. It has also been associated with functional decline, decreased quality of life and increased social isolation among the elderly population. This study analyzed predictors of the fear of falling in elderly Portuguese people that live in the community. A cross-sectional study with a convenience sample of 98 participants (57.1% women; mean age 74.07 ± 8.74 years) was conducted. Data were collected with a protocol which includes a questionnaire for sociodemographic and health information, the Activity Specific Balance Confidence Scale, the Hospital Anxiety and Depression Scale, the Lubben Social Network Scale-6, the Timed Up and Go, and Five Times Sit to Stand Test. Data were analyzed using descriptive and inferential statistics. The results showed that female gender (p = 0.01), the perception of good (p = 0.01) and moderate (p = 0.02) physical health and the symptoms of depression (p ≈ 0.00) are predictors of fear of falling. Controlling these predictors is a fundamental aspect for promoting the independence of elderly people minimizing the consequences that are associated with the fear of falling.